Provider Demographics
NPI:1306239538
Name:PRESTON PHARMACY
Entity type:Organization
Organization Name:PRESTON PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF/CONSULTING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:LEW
Authorized Official - Middle Name:R
Authorized Official - Last Name:ENNS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:316-265-3300
Mailing Address - Street 1:2622 W CENTRAL AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-4973
Mailing Address - Country:US
Mailing Address - Phone:316-265-3300
Mailing Address - Fax:
Practice Address - Street 1:2622 W CENTRAL AVE STE 302
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-4973
Practice Address - Country:US
Practice Address - Phone:316-265-3300
Practice Address - Fax:316-265-3304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-12291183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty